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Health Governance, Systems and Equity: Finding the right mix in Nigeria

Health Governance, Systems and Equity: Finding the right mix in Nigeria

Held on 19 November, 2015, this event marked 20 years of collaboration for the HP Network in Nigeria.

The morning began with presentations around the theme which were followed by a panel discussion. The presentations sparked stimulating discussion and asked numerous questions such as: What are the appropriate governance structures for Nigeria’s health sector that will ensure effective delivery of health services, while also providing accountability, transparency and making sure the money goes where it ought to? Should Local Government Areas (LGAs) be responsible for managing and delivering Primary Health Care (PHC)services, given their poor track record and the massive but unsuccessful efforts to improve their performance? Can you have community involvement if the LGA’s are not responsible for PHC services?

Key central themes emerged including: the vital importance of executing the Health Act effectively, with support for States from the Federal Ministry of Health and National Primary Health Care Development Agency (NPHCDA); the necessity of political leadership to achieve results in PHC strengthening; the value of establishing community as well as individual responsibility for the health care of women in northern Nigeria; LGA accountability and their essential role in community involvement, citizen voice and wider cross sector engagement; the significance of ending fragmentation and achieving “PHC Under One Roof” (PHCUOR); the important role that good financial management plays in delivering better health services and communities’ voices and users of health services are crucial for strengthening the Nigeria health system.

The panel discussion on ‘The role of health systems strengthening in achieving Universal Health Care’ asked us to consider Universal Health Care (UHC) as a blueprint and rather than keeping the discussion focused on the Federal level, pay greater attention to the States, which have the most important role in organising better health care and service delivery.

The success of the Jigawa State example of the Gunduma Health System was highlighted. The state undertook major reforms in the organisation of health services, with a considerable increase in funding and a dynamic shift of power to end fragmentation, integrate management, major control in managing the health workforce, establish single channels for disbursing funds and ensure clear lines of accountability and reporting.

“HPI’s careful approach over many years was the backbone of our success in dramatically improving health outcomes in Jigawa State”, said the Dr Hassana, Ex-Commissioner of Jigawa State and first Chief Executive of the Jigawa State Gunduma Board (pictured).

Strengthening Primary Health Care and its link to UHC was also emphasised as was the need for increased government funding to achieve scale up, while recognising that donor support though highly valued contributes only a very small amount in financing the Nigerian health sector. However partnership between donors, government and the private sector is essential in achieving UHC. Also essential is establishing a unified health system that linked together all three levels (Federal, State and Local Government) and provided an integrated network of care. The prime responsibility of the Federal level was discussed and agreed that it was to support and oversee the State level, which in turn needed to focus on supporting and overseeing the delivery of care. The implementation of the new Health Act was a one-time opportunity, which must not be lost.